早期目标导向活动对胰腺术后胃肠功能恢复的影响

doi:10.3969/j.issn.1674-8115.2024.10.004

上海交通大学学报（医学版） ›› 2024, Vol. 44 ›› Issue (10): 1235-1240.doi: 10.3969/j.issn.1674-8115.2024.10.004

• 临床护理专题 • 上一篇

早期目标导向活动对胰腺术后胃肠功能恢复的影响

姚晖(), 张贇, 戴晨珺, 高雯晴, 姚文洁, 段晓磊, 杨富

上海交通大学医学院附属第一人民医院护理部，上海 200080

收稿日期:2024-04-02 接受日期:2024-07-31 出版日期:2024-10-28 发布日期:2024-10-28
通讯作者: 姚晖 E-mail:15202112941@126.com
基金资助:
上海交通大学医学院科技基金(Jyhz2118);复旦大学循证护理中心证据转化与临床应用项目(Fudanebn202339);上海市第一人民医院特色研究项目资助(CCTR-2022N05)

Effect of early goal-directed activity on gastrointestinal function recovery after pancreatic surgery

YAO Hui(), ZHANG Yun, DAI Chenjun, GAO Wenqing, YAO Wenjie, DUAN Xiaolei, YANG Fu

Department of Nursing, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200080, China

Received:2024-04-02 Accepted:2024-07-31 Online:2024-10-28 Published:2024-10-28
Contact: YAO Hui E-mail:15202112941@126.com
Supported by:
Science and Technology Foundation of Shanghai Jiao Tong University School of Medicine(Jyhz2118);Evidence Translation and Clinical Application Project of Center for Evidence-Based Nursing of Fudan University(Fudanebn202339);Featured Research Project of Shanghai General People's Hospital(CCTR-2022N05)

摘要/Abstract

摘要：

目的·探讨早期目标导向活动（early goal-directed mobilization，EGDM）对胰十二指肠切除术后胃肠功能恢复的有效性和安全性。方法·采用非同期对照研究，2022年9月—2023年5月选取40名胰十二指肠切除术患者为对照组，2023年6月—2024年2月选取40名胰十二指肠切除术患者为试验组。收集2组一般资料。对照组采用胰十二指肠切除术后护理常规，早期活动方面患者下床活动时间、活动目标不做具体要求。试验组在早期活动方面设置每日活动目标，指导患者及家属进行EGDM。有效性评价主要指标为术后排气排便时间；次要指标包括术后首次下床时间，首次经口饮水时间，术后胃管拔除时间，术后第3天K⁺、Na⁺、Cl^-水平。安全性评价包括乳糜漏、胰瘘、胆瘘、胃排空延迟、术后出血、非计划二次手术、非计划拔管、跌倒、死亡。结果·2组患者的一般临床资料差异均无统计学意义。相比对照组，EGDM实施后，首次排气时间由（3.95±1.68）d提前至（2.88±0.91）d（t=-3.560，P=0.001），首次排便时间由（4.90±1.61）d提前至（3.80±1.30）d（t=-3.352，P=0.001），术后首次下床时间由术后（5.18±1.77）d提前至术后（2.30±0.88）d（t=-9.205，P<0.001），首次经口饮水时间由（4.10±1.89）d提前至（2.73±1.20）d（t=-3.883，P<0.001），术后第3天Na⁺（t=-2.745，P=0.008）、Cl^-（t=-2.033，P=0.045）水平差异具有统计学意义。2组均未发生出血、非计划二次手术、非计划拔管、跌倒、死亡不良事件。结论·EGDM方案对促进胰十二指肠切除术后胃肠功能恢复是安全有效的，在术后恢复方面具有一定优势。

关键词: 胰十二指肠切除术, 术后胃肠功能障碍, 早期目标导向活动

Abstract:

Objective ·To investigate the safety and feasibility of early goal-directed mobilization in the recovery of gastrointestinal function after pancreaticoduodenectomy. Methods ·The non-contemporaneous controlled studies were conducted. Subjects who underwent pancreaticoduodenectomy were included. From Sep 2022 to May 2023, forty patients were selected as the control group, and forty patients were selected from June 2023 to February 2024 as the experimental group. The general clinical data of the two groups were collected. The control group was treated with the nursing routine after pancreaticoduodenectomy, and there were no specific requirements for the time and goal of early activity. The experimental group had daily activity goals established for early mobilization, which were performed by the patients and their families, while the rest of their care was identical to that of the control group. The main index of effectiveness evaluation was the time of first flatus and first defecation, and the secondary indexes included the time of first getting out of bed, the time of oral drinking, the time of the gastric tube removal, and the postoperative levels of K⁺, Na⁺, and Cl^- on the 3rd day of the postoperative period. Safety evaluations included chyle leak, postoperative pancreatic fistula, biliary leak and delayed gastric emptying, postoperative hemorrhage, unplanned reoperation, unplanned extubation, falls and death. Results ·There was no statistically significant difference in the general clinical data of the patients in the 2 groups. After the implementation of early goal-directed mobilization, the time of first flatus was advanced from (3.95±1.68) d to (2.88±0.91) d (t=-3.560, P=0.001), and the time of first defecation was advanced from (4.90±1.61) d to (3.80±1.30) d (t=-3.352, P=0.001). The time of first getting out of bed was advanced from (5.18±1.77) d to (2.30±0.88) d (t=-9.205, P<0.001), and the time of oral drinking was advanced from (4.10±1.89) d to (2.73±1.20) d (t=-3.883, P<0.001). Significant differences were also observed in postoperative day 3 Na⁺ (t=-2.745, P=0.008) and Cl^- (t=-2.033, P=0.045) levels. Conclusion ·Early goal-directed activity programs are safe and effective in promoting the recovery of gastrointestinal function after pancreaticoduodenectomy.

Key words: pancreaticoduodenectomy, postoperative gastrointestinal dysfunction, early goal directed mobilization (EGDM)

中图分类号:

R473.6

姚晖, 张贇, 戴晨珺, 高雯晴, 姚文洁, 段晓磊, 杨富. 早期目标导向活动对胰腺术后胃肠功能恢复的影响[J]. 上海交通大学学报（医学版）, 2024, 44(10): 1235-1240.

YAO Hui, ZHANG Yun, DAI Chenjun, GAO Wenqing, YAO Wenjie, DUAN Xiaolei, YANG Fu. Effect of early goal-directed activity on gastrointestinal function recovery after pancreatic surgery[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2024, 44(10): 1235-1240.

图/表 3

参考文献 15

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Item	Experimental group (n=40)	Control group (n=40)	χ²/t value	P value
Gender/n(%)			1.342	0.184
Male	16 (40.0)	22 (55.0)
Female	24 (60.0)	18 (45.0)
Age/year	59.3±12.01	62.4±10.97	-1.186	0.239
BMI/(kg·m^-2)	22.08±3.44	22.64±2.90	-0.781	0.437
Before surgery
CRP/(mg·L^-1)	11.05±29.31	16.86±46.19	-0.671	0.504
K⁺/(mmol·L^-1)	3.91±0.36	3.81±0.32	1.346	0.182
Na⁺/(mmol·L^-1)	140.78±2.84	140.95±2.41	-0.293	0.770
Cl^-/(mmol·L^-1)	105.27±3.44	106.03±3.02	-1.058	0.293
Alb/(g·L^-1)	36.43±4.44	37.53±4.64	-1.083	0.282
PA/(mg·L^-1)	208.84±58.96	222.83±73.58	-0.938	0.351
RBP/(mg·L^-1)	31.33±10.08	35.54±10.47	-1.833	0.071
D-Dimer/(mg·L^-1)	0.58±0.49	0.75±0.63	-1.385	0.170
Pathological type/n(%)			-0.827	0.411
PCN	7 (17.5)	9 (22.5)
Ductal adenocarcinoma	31 (77.5)	29 (72.5)
CP	2 (5.0)	0 (0)
PanIN	0 (0)	1 (2.5)
Duodenal stromal tumor	0 (0)	1 (2.5)

Item	Experimental group (n=40)	Control group (n=40)	χ²/t value	P value
Gender/n(%)			1.342	0.184
Male	16 (40.0)	22 (55.0)
Female	24 (60.0)	18 (45.0)
Age/year	59.3±12.01	62.4±10.97	-1.186	0.239
BMI/(kg·m^-2)	22.08±3.44	22.64±2.90	-0.781	0.437
Before surgery
CRP/(mg·L^-1)	11.05±29.31	16.86±46.19	-0.671	0.504
K⁺/(mmol·L^-1)	3.91±0.36	3.81±0.32	1.346	0.182
Na⁺/(mmol·L^-1)	140.78±2.84	140.95±2.41	-0.293	0.770
Cl^-/(mmol·L^-1)	105.27±3.44	106.03±3.02	-1.058	0.293
Alb/(g·L^-1)	36.43±4.44	37.53±4.64	-1.083	0.282
PA/(mg·L^-1)	208.84±58.96	222.83±73.58	-0.938	0.351
RBP/(mg·L^-1)	31.33±10.08	35.54±10.47	-1.833	0.071
D-Dimer/(mg·L^-1)	0.58±0.49	0.75±0.63	-1.385	0.170
Pathological type/n(%)			-0.827	0.411
PCN	7 (17.5)	9 (22.5)
Ductal adenocarcinoma	31 (77.5)	29 (72.5)
CP	2 (5.0)	0 (0)
PanIN	0 (0)	1 (2.5)
Duodenal stromal tumor	0 (0)	1 (2.5)

Item	Experimental group (n=40)	Control group (n=40)	H/t value	P value
Primary index
The time of first flatus/d	2.88±0.91	3.95±1.68	-3.560	0.001
The time of first defecation/d	3.80±1.30	4.90±1.61	-3.352	0.001
Secondary index
The time of first getting out of bed/d	2.30±0.88	5.18±1.77	-9.205	<0.001
The time of oral drinking/d	2.73±1.20	4.10±1.89	-3.883	<0.001
Gastric tube removal time^①/d	5.32±1.45	6.10±3.12	0.290	0.590
D3 K⁺/(mg·L^-1)	3.89±0.42	3.76±0.44	1.390	0.169
D3 Na⁺/(mg·L^-1)	138.88±3.10	140.79±3.11	-2.745	0.008
D3 Cl^-/(mg·L^-1)	102.87±3.65	104.66±4.19	-2.033	0.045

Item	Experimental group (n=40)	Control group (n=40)	H/t value	P value
Primary index
The time of first flatus/d	2.88±0.91	3.95±1.68	-3.560	0.001
The time of first defecation/d	3.80±1.30	4.90±1.61	-3.352	0.001
Secondary index
The time of first getting out of bed/d	2.30±0.88	5.18±1.77	-9.205	<0.001
The time of oral drinking/d	2.73±1.20	4.10±1.89	-3.883	<0.001
Gastric tube removal time^①/d	5.32±1.45	6.10±3.12	0.290	0.590
D3 K⁺/(mg·L^-1)	3.89±0.42	3.76±0.44	1.390	0.169
D3 Na⁺/(mg·L^-1)	138.88±3.10	140.79±3.11	-2.745	0.008
D3 Cl^-/(mg·L^-1)	102.87±3.65	104.66±4.19	-2.033	0.045

Item	Experimental group (n=40)	Control group (n=40)	χ² value	P value
Safety of early goal directed mobilization/n(%)			0.156	0.692
Number of patients without complications	37 (92.5)	36 (90.0)
Chyle leak	1 (2.5)	1 (2.5)
POPF	1 (2.5)	1 (2.5)
Biliary leak	1 (2.5)	0 (0)
DGE	0 (0)	2 (5.0)

早期目标导向活动对胰腺术后胃肠功能恢复的影响

Effect of early goal-directed activity on gastrointestinal function recovery after pancreatic surgery

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